Provider Demographics
NPI:1184624215
Name:REITZELL, DANIEL B (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:REITZELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:LA
Mailing Address - Zip Code:71417-0268
Mailing Address - Country:US
Mailing Address - Phone:318-627-5428
Mailing Address - Fax:318-627-4187
Practice Address - Street 1:615 8TH ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:LA
Practice Address - Zip Code:71417-1414
Practice Address - Country:US
Practice Address - Phone:318-627-5428
Practice Address - Fax:318-627-4187
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist